Role of Magnetic Resonance Spectroscopy in Differentiating Neoplastic From Non- Neoplastic Ring Enhancing Brain Lesions Taking Surgical Findings as Gold Standard

Abstract

Objective: To evaluate the diagnostic accuracy of Magnetic Resonance spectroscopy (MRS) in distinguishing neoplastic from non-neoplastic ring enhancing brain lesions taking histopathological findings as gold standard. Study Design and Setting: The cross sectional study was conducted at Radiology department of Jinnah Postgraduate Medical Centre. Methodology: Total 102 patients with ring enhancing lesions detected on MRI brain contrast studies were selected for this study. Cases were referred from Outpatient Department of Neurology Clinics who were suspected of having space occupying lesions in brain. Full history, clinical examination and laboratory investigations (Complete Blood Count and ESR) were carried out. The patients having claustrophobia, metallic implants, cardiac pacemaker and having metallic foreign body in situ were excluded from the study. Informed consent was taken from the research and MRS was performed. On MRS, lesion was categorized and final diagnosis was taken based on histopathology results. All the information was recorded into predesigned proforma. Patients Data was scrutinized by using Statistical Package for Social Sciences (SPSS 21.0). Mean + SD was calculated for age, gender, duration of symptoms and size of the lesion. Results: The average age of the patients was 35.45±10.36 years. Sensitivity, specificity, PPV, NPV and accuracy of MRS was 87.5%, 93.3%, 95.5%, 89.7% and 92.1% respectively. Conclusion: Magnetic resonance spectroscopy can be effective in discerning neoplastic from non-neoplastic ring enhancing cerebral lesions, thus avoiding an invasive procedure like brain biopsy

Accuracy of Proton Magnetic Resonance Spectroscopy in Distinguishing Neoplastic From Non-neoplastic Brain Lesions

“…In the current study, the mean choline/NAA ratio in neoplastic lesions was significantly high compared to the mean ratio in non-neoplastic lesions. Our results contrast with the study done by Jesrani et al [ 14 ]. They revealed histopathological analysis and reported that 43.1% of cases were neoplastic, while 56.9% were non-neoplastic.…”

“…MRI along with MRS is a good diagnostic tool when compared to MRI alone, as it has good sensitivity and specificity. This was comparable with the study conducted by Jesrani et al [ 14 ]. The findings of their study show a sensitivity of 87.5%, specificity of 93.3%, and accuracy of 92.1%.…”

Clinical Application of Magnetic Resonance Spectroscopy in Diagnosis of Intracranial Mass Lesions

“…Increased choline in the peritumoural oedema would greatly increase the confidence of diagnosing a high-grade glioma. Differentiation of tumour from nonneoplastic lesions is possible using NAA/Cho and NAA/Cr ratios, with high choline levels seen in the neoplastic lesions [ 21 ].…”